By Sabrina Sales Martinez, MS, RDN

In the United States, more than 35% of the adult population and 17% of children and adolescents are obese [1-2]. Overconsumption of calories has been contributing to the rise in obesity, and fast food restaurants are often mentioned as a possible culprit. Fast food menu items have been shown to be lower in nutritional quality, higher in saturated fat and misaligned with national dietary guidelines. Often, full-service restaurants are thought to offer higher quality foods and healthier menu options. Data on the nutritional quality of foods sold in full-service restaurants, however, is lacking. According to a recent article in the Journal of Nutrition Education and Behavior, there may be a misconception that full-service restaurants are healthier than fast food restaurants.

A recently published article by Auchincloss and colleagues [3] may provide much needed information on full-service restaurants and the nutritional content of their menu items. The researchers at Drexel University and University of Pennsylvania reviewed menus from 21 full-service chain restaurants in Philadelphia at different price points and over 2,600 menu items. Menu items that were labeled as being healthier options were also compared to the US Dietary Guidelines. Restaurants were included if they provided calorie and sodium information for all menu items and if most of their main dishes were single serving entrees. Their results showed that on average a la carte entrees and appetizers were about 800 kcalories and 50% did not meet the healthier criteria set by the authors based on the US Dietary Guidelines. About one-third of the entrees and appetizers exceeded the dietary reference values (DRV) for a 2,000 kcalorie diet for adults and 1,400 kcalorie diet for children for saturated fat and sodium. In addition, only 20% of the items met minimum fiber recommendations. The most astonishing findings from this study was that, on average, a meal that consisted of an adult entrÉe, side dish and shared appetizer provided about 1,495 kcalories, 28 grams of saturated fat, 3,312 mg of sodium and 11 grams of fiber. If a non-alcoholic beverage and dessert was added to the meal, then it totaled 2,020 kcalories, 39 grams of saturated fat, 3,760 mg sodium and 12 grams of fiber. Yes, one meal exceeded the average adult’s energy needs for the day! Other important findings include that menu items targeted to seniors had surpassed the DRV for saturated fat and sodium, and that those mostly targeted to children exceeded calorie and sodium DRVs.

The results from the study by Auchincloss and colleagues [3] are welcomed, because as previously mentioned, data on the nutritional quality of menu items in full-service restaurants are scarce. Considering that full-service chain restaurants control most of the US restaurant market and that almost half of food expenditures are from restaurants [4], this study provides important information that can be translated into nutrition education for the restaurant customer. Most of the healthy labeled items at these restaurants only considered calories as a criterion for being “healthy” and only half of the restaurants offered a healthier option.

This study only provides the starting point in addressing the nutritional quality of meals in restaurants, and the authors hope that these data can be compared to future studies to see whether changes occur in providing healthier options and whether these options are implemented at the request of consumers or due to regulation. As part of the Affordable Health Care Act of 2010 all restaurants with greater than 20 locations will need to provide menu labeling and the customers will need to have the necessary tools to understand the meaning of these labels and its implications for their health. Findings from present and future studies should be used to propose and implement interventions and/or strategies that can be used to bring about awareness to the restaurant industry and its consumers of the recommended dietary intakes and adoption of healthier menu options. Examining the nutritional quality of restaurant meals may be a worthwhile public health endeavor to reduce obesity, its associated health conditions and their financial burden in medical expenses, especially when there is a strong trend towards consuming increased number of meals outside the home, and there is evidence that these meals may be higher in calories, saturated fat and sodium. In these conditions, establishing criteria for healthier options for restaurants may be warranted.

The authors have made recommendations to restaurants based on their findings.

1. Centers for Disease and Control (CDC). Overweight and Obesity: Adult Obesity Facts.
2. Centers for Disease and Control (CDC). Overweight and Obesity: Childhood Obesity Facts.
3. Auchincloss AH, Leonberg BL, Glanz K, Bellitz S, Ricchezza A, Jervis A. Nutritional Value of Meals at Full-service Restaurant Chains. J Nutr Educ Behav. 2014 Jan;46(1):75-81. doi: 10.1016/j.jneb.2013.10.008.
4. Industry at a glance. National Restaurant Association website.